Hip Impingement (FAI)

What is Hip Impingement?

Femoroacetabular impingement (FAI) is a condition where there’s abnormal contact between the ball (femoral head) and socket (acetabulum) of the hip joint due to altered bone shape. This creates pinching of the soft tissues — particularly the labrum and cartilage — during certain movements, typically when the hip is flexed and rotated.

There are two main types. Cam impingement: extra bone growth on the femoral head (the ball), creating a bump that jams into the socket during deep hip flexion. Pincer impingement: extra bone or abnormal orientation of the acetabulum (the socket), causing it to over-cover the ball and pinch the labrum. Many people have a mixed pattern — both cam and pincer features.

Here’s the critical thing most people don’t understand: loads of people have FAI changes on scans who have no pain or functional problems at all. Research shows that 30-40% of asymptomatic athletes have cam morphology on imaging.

Having impingement on a scan doesn’t automatically mean you need surgery or that you’re destined for hip arthritis. What matters is whether the impingement is causing symptoms and affecting your function, and whether conservative management can resolve those symptoms.

What Causes Hip Impingement Symptoms?

The bone shape abnormality is usually developmental — it formed during adolescence, often in people who did high-impact sports during growth years. Football, rugby, hockey, and other sports involving repetitive hip flexion and rotation are common in the history of people with cam morphology.

But having the bone shape doesn’t automatically cause pain. Symptoms typically develop when you ask the hip to do movements it doesn’t tolerate well — deep squatting, prolonged sitting, certain running mechanics, or high training loads.

Common triggers I see across Liverpool, Chester, and Queensferry: gym-goers who’ve started doing heavy squats or deadlifts with deep hip flexion, runners increasing mileage or speed work, cyclists spending hours in a flexed hip position, and people returning to sport after time off who’ve ramped up intensity too quickly.

Age matters too. Young athletes in their 20s and 30s often develop symptoms as they increase training loads. People in their 40s and 50s sometimes develop symptoms as degenerative changes start happening alongside the impingement.

Symptoms of Hip Impingement

Classic presentation: deep groin pain, often a C-sign (you make a C-shape with your hand around the front and side of your hip when describing where it hurts). Pain is worse with hip flexion — squatting, sitting for long periods, getting in and out of cars, putting on shoes.

Many people describe a pinching or catching sensation in the front of the hip during certain movements. There might be clicking, though not all clicking is FAI — some clicking is benign and not associated with pain.

Stiffness in the hip, particularly into flexion and internal rotation. You might notice you can’t squat as deep as you used to, or that one hip feels stiffer than the other.

Pain often comes on gradually with activity and eases with rest, but in more severe cases it can be present at rest or at night.

Common among gym-goers across Merseyside who’ve been squatting heavy for years, runners from Chester with high mileage, and cyclists from Cheshire and North Wales spending long hours on the bike.

What You Can Expect in Your Assessment

I’ll take a detailed history — when symptoms started, what movements aggravate them, what your training or sport involves, whether symptoms are affecting daily activities.

Then I’ll assess your hip — range of movement in all directions (particularly flexion and internal rotation, which are often restricted in FAI), specific impingement tests (FADIR, FABER), strength testing of the hip and core muscles, and functional movement assessment.

Often I’ll watch you squat, lunge, or perform movements relevant to your sport or training to understand how your hip is moving and where the impingement might be occurring.

I’ll screen for other causes of groin pain — adductor strains, sports hernias, lumbar spine referred pain — because “groin pain” doesn’t always come from the hip joint.

By the end of the session, you’ll have:

Do I Need a Scan?

Maybe. Hip impingement can often be suspected clinically based on symptoms and examination findings, but imaging is usually needed to confirm the diagnosis and assess the severity of structural changes.

X-rays show the bone morphology — whether you’ve got cam, pincer, or mixed impingement. They’re the first-line investigation.

MRI (or MR arthrogram) shows the soft tissues — labral tears, cartilage damage, and other intra-articular pathology. This is more relevant if you’re considering surgery, as it helps plan the procedure.

Here’s my approach: if your symptoms are mild and you’re willing to try conservative management first, we can start rehab based on clinical suspicion of FAI and arrange imaging later if symptoms don’t improve.

If symptoms are severe, you’re considering surgical referral, or the diagnosis is unclear, imaging sooner makes sense.

If imaging is needed, I’ll guide you on the best route — NHS referral via your GP (free but slower), or private X-ray and MRI if you want results quickly.

Why Conservative Management Works for Many People

You can’t change the bone shape with physio, but you can change how the hip functions and how much load you’re putting through the impingement zone.

Here’s what conservative management targets:

Improving hip mobility: Increasing range of movement in non-impinging directions. Better hip extension, abduction, and external rotation reduces compensatory movement elsewhere and often eases symptoms.

Strengthening hip and core muscles: Strong glutes, hip stabilisers, and core muscles control hip movement better, reducing excessive anterior (forward) translation of the femoral head that exacerbates impingement.

Modifying aggravating movements: You don’t need to stop squatting or running entirely. You need to modify how you do them — adjusting squat depth, changing stance width, altering running mechanics, reducing volume temporarily. This allows you to stay active while managing symptoms.

Load management: Reducing overall training load temporarily while building capacity, then gradually increasing volume and intensity within tolerance.

Many people with FAI respond well to this approach and return to full activity without needing surgery. Success rates for conservative management vary in the research — somewhere between 30-70% depending on severity and activity demands — but it’s worth trying before considering surgery.

What Does Hip Impingement Rehab Involve?

Here’s what most FAI rehab programmes include:

Hip mobility work: Improving range of movement, particularly hip extension, external rotation, and abduction. Better mobility in these directions takes stress off the impingement zone.

Glute and hip strengthening: Strong glutes control hip movement and reduce excessive anterior hip translation during squatting and running. This is non-negotiable.

Core stability: Good core control reduces compensatory lumbar spine movement and improves hip mechanics. Weak core means your hip has to work harder and is more likely to move into impinging positions.

Movement pattern modification: Teaching you how to squat, deadlift, lunge, and run with mechanics that reduce impingement. Often this involves wider stance, limiting hip flexion depth, and cueing better hip hinge patterns.

Activity modification: Temporarily reducing or avoiding movements that aggravate symptoms while maintaining fitness through non-aggravating activities. You might need to reduce squat depth, swap deep squats for box squats, or modify cycling position.

Gradual return to full training: Progressive reintroduction of previously aggravating movements as symptoms settle and strength improves. This is structured and based on symptom response, not guesswork.

How Long Does Recovery Take?

Realistic timescales for conservative management of FAI:

Acute flare-up of symptoms: 4-8 weeks to settle significantly with appropriate activity modification and targeted rehab. Some people feel better within 2-3 weeks, others take the full 8 weeks.

Comprehensive rehab programme: 12-16 weeks to build hip and core strength, improve mobility, modify movement patterns, and return to full training or sport.

Long-term management: Ongoing. FAI is a structural issue that doesn’t go away. Even if symptoms resolve completely, you’ll need to maintain strength and monitor training load to prevent symptom recurrence.

Not everyone responds to conservative management. If you’ve done 3-6 months of good quality physio with minimal improvement, surgical referral might be appropriate.

Post-surgical rehab (if you eventually need surgery): 4-6 months to return to normal activities, 9-12 months for return to high-level sport. Recovery is slow and progressive because the hip capsule, labrum, and cartilage need time to heal.

When to Book an Assessment

Location and Booking

I run a clinic in Chester, with appointments available Monday, Wednesday, Thursday, and Friday.

Whether you’re a gym-goer across Cheshire dealing with hip pain during squats, a runner from Chester with deep groin discomfort, or a cyclist from Cheshire struggling with hip symptoms after long rides, I can help.

Book online to see available slots, or get in touch if you’ve got questions before booking.

No hard sell. No obligation. Just honest physio focused on getting you a clear diagnosis, understanding whether you can manage this conservatively, and giving you a structured plan to get back to training or sport.